Daniel Messelken

This paper examines the question whether physicians are obligated by their professional ethos to defend a pacifist position. The question is a more concrete and applied formulation of the general thesis that there are what I will call “pacifist professions”: professions whose ethos requires their members to act in a pacifist way. Since the present paper is rather one in applied philosophy than a theoretical one about the foundation of pacifism, it will concentrate on the practical issue of whether and how physicians can execute their profession in or during war. Theoretical questions on the nature and extent of pacifism will be considered only to the extent necessary to treat the main issue. The introductory section will give a short overview of some histori- cal aspects of physicians’ participation in war and show the relevance of the issue with recent examples. The remainder of this section will thus serve to set the stage and to outline the connections between the medical profession and questions of war and peace. The paper will then be divided into three other main parts: the first part will be devoted to defining in a general manner so-called “professional pacifism”. The second part will investigate whether and to what extent the medical profession can be classified as a pacifist profession, and the third part will look at the consequences of such a classification.

Der Einfluss der Lehre vom gerechten Krieg bzw. der Idee des gerechten Friedens auf den Umgang mit heutigen Konflikten lässt sich besonders gut anhand der so genannten „humanitären Interventionen“ und dem aus dieser Praxis entwickelten neuen Ansatz der „Responsibility to Protect“ (RtoP/ R2P) bzw. Schutzverantwortung zeigen. Bei der Be- gründung als humanitär erachteter Interventionen seit den 1990er Jahren wurde und wird auf die Kriterien des gerechten Krieges bzw. gerechten Friedens zurückgegriffen. Nachfolgend spielten diese auch bei der Formulierung des Prinzips der Schutzverantwor- tung eine wichtige Rolle und sind so erneut für die Ausbildung völkerrechtlicher Normen herangezogen worden. Im Folgenden soll zunächst kurz das Kernproblem humanitär begründeter Interventionen skizziert werden und in einem zweiten Schritt dann gezeigt werden, wie die Konzepte von gerechtem Krieg und gerechtem Frieden in der Denkweise und den Prinzipien der Schutzverantwortung verankert sind.

Over the last few years, virtually all forms of non-state violence have been labeled as “terrorism”. As a result, differences between various forms of war and violence are lost in the analysis. This article proposes a conceptual distinction between terrorism and guerrilla warfare by analyzing their differences and similarities. Definitions of terrorism and guerrilla warfare are presented. Starting with these definitions, the question of the legitimacy of terrorism and guerrilla violence is answered with reference to just war theory. Particular attention is paid to the issue of the so called “innocent victims” of terrorism.

Ideally, the (ethical) principles of medical care remain unaltered during armed conflict and can be interpreted as a remnant of peace during war. Healthcare providers also support future peace by not discriminating according to the conflict roles between enemy and friend or fighter and civilian, but by respecting everybody, in a non-conflict logic, as human beings. The antithetical view identifies medical care for wounded soldiers as a contribution to a threat. This chapter rejects such an interpretation, which can be found in parts of the revisionist just war theory, because it carelessly ignores the non-conflict logic, which is fundamental to the medical role. The aim of this chapter is twofold: (i) to show that and for which reasons medical care should not count as a contribution to a threat and (ii) to point out how medical care should be conceived in order to implement and defend its inherent peace-logic.

Battlefield euthanasia, the purposeful killing of wounded soldiers (or even civi- lians) in order to hasten their foreseeable death, has been an issue in military medicine and in soldiers’ moral codes at all times. During conflicts since anti- quity, there have been severely wounded who would not die immediately but whose fate seemed clear, nevertheless. But can it ever be morally justified to kill those wounded out of mercy in order to end their suffering? Can death ever be the better option? And if so, what conditions have to be fulfilled? This paper investigates some of the moral aspects of battlefield euthanasia. Analogies to physician-assisted suicide in civil settings will be drawn and contrasted with the additional aspects that the military environment adds to the problem.

Minors are increasingly reaching countries far from their homes as migrants, and their ages are often unknown. In Europe, up to 1500 people per country annually have medical examinations and procedures to estimate their chronological age.1 These procedures can cause considerable harm to individuals, particularly if performed without appropriate safeguards. Inappropriate age estimation may deter minors from applying for asylum in specific countries, and doctors may find themselves exploited in the service of migration policy. During missions, military doctors face demands to estimate the age of child soldiers destined for potentially unlawful detention or interrogation. Doctors therefore need to be aware of the limitations of medically estimating age and the associated ethical problems.

This book sheds light on various ethical challenges military and humanitarian health care personnel face while working in adverse conditions. Contexts of armed conflict, hybrid wars or other forms of violence short of war, as well as natural disasters, all have in common that ordinary circumstances can no longer be taken for granted. Hence, the provision of health care has to adapt, for example, to a different level of risk, to scarce resources, or uncommon approaches due to external incentives or requirements. This affects the practice of health care as well as its ethics. This book offers a panoramic overview on various challenges healthcare faces in extraordinary situations and provides new insights from practitioners’ as well as from academic scholars’ perspectives.

Changing faces of war and war-like situations have led in recent years to new forms of military deployment. They range from the so called "war on terrorism" with e.g Operation Enduring Freedom or humanitarian interventions (e.g. Kosovo 1999) to deployments within disaster relief missions as lately in Haiti. These pose not only moral, legal, and organizational challenges to states and the international community but also put individual soldiers and military (medical) personnel in situations that their classical formation does not prepare them for. For they face (i) situations not sufficiently covered/ regulated by international humanitarian (IHL) law and/or (ii) tasks that are not within the range of the "classical soldier". These changing needs require new forms of education in the military and highlight the role of ethical education as many of the dilemmas cannot be resolved by sole reference to the IHL. In addition to a solid knowledge of the law of armed conflict (LOAC), military personnel should therefore acquire fundamental skills of ethical reasoning in dilemma situations. Our article aims at (i) outlining the goals of a military medical ethics education that responds to these needs and the practical challenges of present-day military deployment and (ii) present how the ICMM tries to integrate these goals in its educational program.

In emergency situations and while medical resources are sufficient, doctors are expected to prioritize and treat patients according to medical criteria only. In MASSCAL situations and when medical resources become insufficient, patient selection and prioritization changes. Rules of triage are applied with the aim of getting the best result possible under the circumstances, e.g., saving the largest number; collective health outweighs individual health. Still, according to the standard ethical principles, non-medical criteria should never influence the doctors’ decision of who will be treated. In military contexts, so-called medical rules of eligibility (MROE) provide rules that include non-medical criteria. This chapter aims to analyze if, why, and under what circumstances it may be ethically acceptable to prioritize patients according to non-medical criteria.

Das Spektrum dessen, was als Gewalt bezeichnet wird, ist groß. Es reicht von paradigmatischen Fällen wie kriegerischen Konflikten und Terrorismus über Mord durch Erschlagen und Körperverletzungen bis hin zu umstritteneren Beispielen wie struktureller, sozialer, psychologischer oder verbaler Gewalt. Gewalt muss daher als eine anthropologische Konstante bezeichnet werden: Die Fähigkeit, andere zu verletzen, und die Eigenschaft, von anderen verletzt zu werden, sind Teile der menschlichen Natur. Gewalt ist auch als „Universalsprache“ bezeichnet worden.

Outbreaks of epidemics like Ebola trigger difficult ethical challenges for civilian and military health care personnel. This book offers theoretical reflections combined with reports from recent military and NGO missions in the field. The authors of this volume focus on military medical ethics adding a distinct voice to the topic of epidemics and infectious diseases. While military health care personnel are always crucially involved during disaster relief operations and large-scale public health emergencies, most of the current literature treats ethical issues during epidemics from a more general perspective without taking into account the specifics of the military context. The contributions in this volume provide first-hand insights into some of the ethical issues encountered by military health care personnel in missions during the Ebola outbreak in 2014/2015. This practical perspective is complimented by academic analyses and theoretical reflections on ethical issues associated with epidemics.

This book focuses on resource allocation in military and humanitarian medicine during times of scarcity and austerity. It is in these times that health systems bend, break, and even collapse and where resource allocation becomes a paramount concern and directly impacts clinical decision-making. Such times are challenging and this book covers this very important, yet, scarcely researched topic within the field of bioethics. This work brings together experts and practitioners in the fields of military health care, philosophy, ethics, and other disciplines to provide analysis on a variety of related topics ranging from case studies and first-hand experiences to policy and philosophical analysis. It is of great interest to to academics, practitioners, policy makers and students who are looking for analyses and guidance regarding the fair provision of medical care and the use of medical rules of eligibility under adverse conditions.

Philosophie nach Georg Meggle zeichnet sich aus durch kommunikative Offenheit, durch begriffliche Unbestechlichkeit und durch ihr Engagement in der Welt. Die Beiträge in diesem Band orientieren sich an diesem Philosophieverständnis und sind aus Anlass eines Symposiums zu Ehren von Georg Meggle als Originalbeiträge geschrieben worden. Der Band verbindet die theoretischen und praktischen Aspekte der analytischen Philosophie: So sind die Essays zur Hälfte der theoretischen, meist sprach-analytischen, zur Hälfte der praktischen, meist praktisch-politischen Philosophie zuzuordnen. Die Texte vereint das Ideal des Strebens nach begrifflicher Klarheit und welthaltiger Relevanz, nach Dialog. Sie beschreiten neue Wege der analytischen Philosophie und weisen somit den Weg in die Zukunft der Philosophie als gesellschaftlich relevanter Disziplin. Mit Beiträgen u.a. von: Franz von Kutschera, Peter Singer, Wolfgang Lenzen, Wolfgang Spohn, Reinhard Merkel, Rainer Hegselmann, Peter Rohs und Georg Meggle.

This chapter introduces to the main topic of the volume, namely the influence of the changing nature of warfare on the provision of medical care and the ethical challenges that occur. It presents the main ideas of relevant concepts such as asymmetrical warfare, hybrid warfare, and complex emergencies before illustrating the ethical challenges that new forms of warfare create for military and humanitarian health care providers. Examples of ethical challenges include embedding medical personnel in combating forces, questions regarding the treatment of detainees, the need to uphold medical neutrality, and pitfalls of using medicine to non-medical ends. The chapter concludes with a synopsis of the volume.

Modern medicine consumes vast amounts of resources, ranging from human to technological and financial. In a well-functioning and well-equipped health system, resource allocation considerations rarely impact clinical decision-making as all patients that need care will (eventually) receive it. In light of this, health care providers (HCPs) are often taught to focus on the patient in front of them, driven by a type of patient-centred ethics (of care) that prioritizes the individual person’s well-being above the aggregate. Informed by the principle of autonomy and respect for individual self-determination, patients in well-resourced health systems often have the autonomy to make decisions that require high resource utilization with little concern directed to how these choices may impact the care provided to other patients or groups of patients. In fact, it is generally accepted that if resources are sufficient, patients and their providers should be able to make medical decisions unencumbered by considerations related to broader resource allocation (with some caveats related to personal or national health insurance schemes). This means that the average HCP in the best case and in their daily routine spends little time considering how their clinical choices might impact the care available to others—concerns related to how resources are allocated, and who receives care are far removed from clinical interaction and related medical decision-making.

Kriege, Terrorismus, Völkermord, humanitäre Interventionen und andere Formen kollektiver Gewalt sind in den letzten Jahren auch in der Philosophie verstärkt in den Blickwinkel gerückt. Dabei wurde der Tradition des 'gerechten Krieges' neue Aufmerksamkeit zuteil und somit der Frage, ob und wann Kriege als 'moralisch gerechtfertigt' bewertet werden können. Die grundlegendere Frage, wie 'Gewalt' definiert werden kann, ist hingegen kaum nicht beachtet worden. Im Mittelpunkt des vorliegenden Buches steht die Frage nach Gründen für die moralische Rechtfertigung oder moralische Verurteilung gewaltsamen Handelns. Zur methodischen Vereinfachung wird nur so genannte interpersonale Gewalt, also der Einsatz von Gewalt durch genau eine Person gegen eine andere Person, betrachtet. Das Buch gliedert sich in drei Teile: Im ersten Teil wird die Idee vom 'gerechten Krieg' vorgestellt und gezeigt, das grundsätzlich auch heute noch an die klassischen Autoren angeknüpft werden kann. Der zweite Teil liefert einen Überblick über philosophische Positionen zum Begriff der Gewalt. Der dritte Teil führt die Ergebnisse zusammen und liefert (i) eine Explikation des Begriffs interpersonaler Gewalt und (ii) einen Rahmen zur Bewertung verschiedener Fälle derartiger Gewalt. Damit eine konkrete Gewaltanwendung als gerechtfertigt gelten kann, muss sie einer Liste von Kriterien genügen. Dieses Buch diskutiert die Bedingungen, die in Ausnahmesituationen vorliegen müssen, damit das prima facie-Verbot des Einsatzes von Gewalt situativ aufgehoben wird und Gewalt moralisch legitim sein kann.

In der philosophischen Literatur finden sich eine ganze Reihe von Positionen zur Definition und zur moralischen Bewertung von Terrorismus. Die meisten Philosophen definieren Terrorismus als eine Form politischer Gewalt. Viele heben die Angsterfahrung der Opfer hervor, die das erste Ziel der Gewalt ist, und unterscheiden sie von weiteren Zielen wie Nötigung oder politischen Veränderungen. In Bezug auf die moralische Bewertung von Terrorismus herrscht Uneinigkeit sowohl was die Grundlage der Bewertung angeht, als auch hinsichtlich des Urteils selbst. Konsequenzialisten bewerten Terrorismus, wie auch andere Handlungen, im Licht seiner Konsequenzen. Deontologen argumentieren hingegen, dass die moralische Bewertung nicht von den Folgen abhängt, sondern vor allem davon, was Terrorismus ausmacht. Folglich schwanken die Positionen zur Moralität von Terrorismus von seiner Rechtfertigung bis hin zu seiner vollkommenen Verurteilung. All diese Positionen kommen in diesem Band zu Wort, der eine Auswahl an philosophischen und politikwissenschaftlichen Essays aus den letzten drei Jahrzehnten versammelt. Die praktische Bedeutung des Themas muss nicht betont werden. Aber Terrorismus ist auch von großem theoretischen Interesse. Denn er liefert eine besonders dramatische Fassung der Frage der Legitimität politischer Gewalt. Und er spitzt eine grundlegende ethische Frage beispielhaft zu: Sollen basale ethische Verbote wie das Verbot des Tötens oder Verstümmelns Unschuldiger als absolute Verbote angesehen werden, oder können sie in Ausnahmefällen angesichts extrem gewichtiger Konsequenzen überschrieben werden?

Scenarios are a key tool for education, training and research in ethics. The presented collection of scenarios in military medical ethics constitutes a valuable resource for trainers and researchers. It shall support deploying military medical personnel and those who organise training and education to better prepare for missions. To achieve this aim, the MME scenario collection • collects and publishes experiences, reports, and scenarios in a searchable database and • provides an opportunity for those returning from missions to (anonymously) contribute their experiences and to share it with others. • Introductory texts and teaching and/or self-learning material shall be added over time. • The thematic scope of the scenario collection could be extended to include ethical challenges of humanitaMrian actors, which are often similar to the experiences of their military counterparts.